Article Figures & Data
Figures
- Figure 1.
Flow chart showing the number of citations retrieved by individual searches and number of trials included in the systematic review.
- Figure 2.
Effect of aldosterone antagonists plus ACEi and/or ARB compared with ACEI and/or ARB alone on the end of treatment proteinuria.
- Figure 3.
Effect of aldosterone antagonists plus ACEi and/or ARB compared with ACEI and/or ARB alone on the end of treatment GFR.
- Figure 4.
Incidence of hyperkalemia with aldosterone antagonists plus ACEi and/or ARB in comparison to ACEI and/or ARB alone.
Tables
- Table 1.
Characteristics of the populations and interventions in the included trials of aldosterone antagonistsa
Study Baseline kidney disease Baseline proteinuria (in g/24 h) or UACR (mean +/− SD) Baseline renal function (ml/min/1.73 m2) No. of patients Intervention Co-intervention in treatment arm(n) (ACEI and/or ARB) Study duration (months) Study end points Bianchi 2006 (23) Idiopathic GN Treatment: 2.1+/−0.08 Control: 2.0+/−0.07 62.3 +/− 1.6 165 Spirinolactone 25 mg daily ACEI alone: 29 ARB alone: 17 ACEI + ARB: 37 12 24 h proteinuria, BP, serum creatinine, eGFR, hyperkalemia, gynecomastia Chrysostomou 2006b (24) Diabetic and non-diabetic nephropathy ACEI alone: 2.6+/− 1.6 ACEI + ARB: 2.5 +/− 1.8 ACEI + Spirinolactone: 2.2+/−1.4 ACEI + ARB + Spirinolactone: 3.1+/− 1.9 ACEI alone: 81.6 ACEI + ARB: 68.0 ACEI + Spirinolactone: 59.4 ACEI + ARB + Spirinolactone: 57.6 41 Spirinolactone 25 mg daily ACEI alone: 10 ACEI + ARB: 10 ACEI + Spirinolactone: 10 ACEI + ARB + Spiriniloactone: 11 6 Primary: 24 h proteinuria Secondary: BP, serum creatinine, Cockraft-Gault creatinine clearance hyperkalemia Epstein 2002 (37) Diabetic nephropathy (Type 2) NA NA 215 EPL 200 mg/d vs. ACEI 40 mg/d vs. EPL 200 mg/d + ACEI 10 mg NA 6 24 h proteinuria, BP, serum creatinine, eGFR, hyperkalemia, gynaecomastia Epstein 2006 (25) Diabetic nephropathy (Type 2) UACR Treatment 50 mg: 422 100 mg: 240 Control: 280 Eplerenone 50 mg: 91 100 mg: 86 Control: 91 268 EPL 50 mg and 100 mg daily ACEI: 268 12 Primary: Percentage change in UACR, incidence of hyperkalemia Secondary: change in BP, eGFR, adverse events, gynaecomastia Furamatsu 2008 (35) Non-diabetic nephropathy > 0.5 g/day (both groups) u-Prot/u-Cr (g/g·Cr) Treatment: 1.42 ±0.28 Control: 1.44 ±0.28 Treatment: 91.8 ±11.8 Control: 68.9 ±7.8 30 Spirinolactone 25 mg daily ACEI + ARB: 30 12 Primary: Reduction in proteinuria Secondary: BP, Cockraft-Gault creatinine clearance, hyperkalemia, gynaecomastia Rachmani 2004 (33) Diabetic nephropathy (Type 2) UACR Treatment: 456 mg/g Control: 451 mg/g Serum creatinine >160 mmol/l 46 Spirinolactone 100 mg daily and decreased to 50 mg daily NA 20 UACR, BP, serum creatinine, hyperkalemia Rossing 2005c (26) Diabetic nephropathy (Type 2) >300 mg/24 h GFR > 30 21 Spirinolactone 25 mg daily NA 2 24 h albuminuria, BP, GFR (based on EDTA), hyperkalemia, Schjoedt 2005c (27) Diabetic nephropathy (Type 1) >300 mg/24 h GFR >30 20 Spirinolactone 25 mg daily NA 2 Primary: 24 h albuminuria Secondary: BP, serum creatinine, GFR (based on EDTA), hyperkalemia, gynaecomastia Schjoedt 2006c (34) Diabetic nephropathy (Type 1 and 2) >2.5 g/24 h GFR >30 20 Spirinolactone 25 mg daily 2 24 h albuminuria, BP, serum creatinine, GFR (based on EDTA), hyperkalemia Tylicki 2008 (36) Non-diabetic nephropathy 0.97 ±0.18 at the randomization point Mean GFR 107.8 (93-140.9) 18 Spirinolactone 25 mg daily ACEI + ARB: 18 2 Primary: 24 h proteinuria Secondary: BP, Cockraft-Gault creatinine clearance, hyperkalemia Van den Meiracker 2006 (32) Diabetic nephropathy (Type 2) Treatment: 0.7 Control: 1.0 Treatment: 87 Control: 64 53 Spirinolactone 50 mg daily ACEI: 17 ARB: 7 12 24 h proteinuria, BP, serum creatinine, eGFR, hyperkalemia, gynecomastia ↵a UACR, Urine Albumin Creatinine Ratio; ACEI, Angiotensin-Converting Enzyme Inhibitor; ARB, Aldosterone Receptor Blocker; GFR, Glomerular Filtration Rate; BP, Blood Pressure; NA, Not available; EPL, Eplerenone; GN, Glomerulonephritis.
↵b This study had 4 arms.
↵c These studies did not report the exact number of patients who had ACEi and/or ARB in treatment and control arm separately.
Aldosterone antagonists for preventing the progression of chronic kidney disease: A systematic review and meta-analysis
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Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease: A Systematic Review and Meta-analysis
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